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General NPI Number Information
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NPI Number | 1598744435
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Entity Type | Organization
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Legal Business Name | CANONSBURG GENERAL HOSPITAL AMBULANCE SERVICE
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Dates
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Enumeration Date | 01/10/2006
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Last Update Date | 11/18/2011
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Provider Practice Location Address
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Address Line | 209 W PIKE ST
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City | CANONSBURG
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State | PA
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Zip | 15317-1143
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Country | US
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Telephone | 724-745-6911
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Fax | 724-745-8919
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Provider Business Mailing Address
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Address Line | PO BOX 207
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City | ALLENTOWN
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State | PA
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Zip | 18105-0207
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Country | US
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Telephone | 484-664-2007
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MR. TERRY M WILTROUT
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Credential |
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Telephone | 724-873-5880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 04005
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License Number State | PA
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